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SUMMARY Background: Electronic cigarettes (e-cigs) have experienced a rapid growth in popularity but little is known about how they are used. Aim: The aim of this study was to identify the e-cig products used by experienced e-cig users, their pattern of e-cig use and the impact on tobacco use. Method: Face-to-face survey of 104 experienced e-cig users. Results: Of all the e-cig users, 78% had not used any tobacco in the prior 30 days. They had previously smoked an average of 25 cigarettes per day, and had tried to quit smoking an average of nine times before they started using e-cigs. Two-thirds had previously tried to quit smoking using an FDAapproved smoking cessation medication. The majority of the sample had used e-cigs daily for at least a year. Three quarters started using e-cigs with the intention of quitting smoking and almost all felt that the e-cig had helped them to succeed in quitting smoking. Two-thirds used e-cig liquid with a medium to high concentration of nicotine (13 mg +). Only 8% were using the most widely sold types of cigarette-sized e-cigs that are typically powered by a single 3.7 volt battery. Instead most used e-cigs designed to enable the atomizer to more consistently achieve a hotter more intense vapour. Conclusion: Until we have more evidence on the safety and efficacy of e-cigs for smoking cessation, smokers should be advised to use proven treatments (e.g. counselling and FDA-approved medicines). However, for those who have successfully switched to e-cigs, the priority should be staying off cigarettes, rather than quitting e-cigs. What’s known

BACKGROUND: Lower rates of smoking cessation and higher rates of lung cancer in African American (AA) smokers may be linked to their preference for mentholated cigarettes. AIM: This study assessed the relationship between menthol smoking, race/ethnicity and smoking cessation among a diverse cohort of 1688 patients attending a specialist smoking cessation service. RESULTS: 46% of the patients smoked mentholated cigarettes, but significantly more AA (81%) and Latino (66%) patients than Whites (32%) smoked menthols. AA and Latino menthol smokers smoked significantly fewer cigarettes per day (CPD) than non-menthol smokers (15.7 vs. 20.3, for AA, and 17.0 vs. 22.1, for Latinos), with no differences among White menthol and non-menthol smokers. At 4-week follow up, AA, Latino and White non-menthol smokers had similar quit rates (54%, 50% and 50% respectively). In contrast, among menthol smokers, AAs and Latinos had lower quit rates (30% and 23% respectively) compared with Whites (43%, p < 0.001). AA and Latino menthol smokers had significantly lower odds of quitting [odds ratio (OR) = 0.34; 95% CI = 0.17, 0.69 for AA, and OR = 0.32; 95% CI = 0.16, 0.62 for Latinos] than their non-menthol counterparts. At 6-month follow up, a similar trend was observed for the race/ethnicity subgroups, with AA menthol smokers having half the odds of being abstinent compared with AA non-menthol smokers (OR = 0.48; 95% CI = 0.25, 0.9). CONCLUSIONS: Despite smoking fewer CPD, AA and Latino menthol smokers experience reduced success in quitting as compared with non-menthol smokers within the same ethnic/racial groups.

Summary Aim: This study aimed to describe the characteristics of treatment-seeking patients who wake at night to smoke (night-smoking), identify factors that may be associated with night-smoking, and assess the association between night-smoking and treatment outcome. Methods: A total of 2312 consecutive eligible cigarette smokers who sought treatment at a specialist tobacco-dependence clinic declared a Target Quit Date, provided baseline information at assessment, and were then followed-up 4 and 26 weeks after their target quit date. Results: Of the total sample, 51.1% were identified as night-smokers and 25.1% reported smoking abstinence at 26-week follow-up. Night-smoking was associated with a number of other patient characteristics, including African-American race or Hispanic ethnicity, having smoking-related medical symptoms, having been treated for a behavioural health problem, smoking mentholated cigarettes, smoking within 30 min of waking in the morning, increased cigarettes smoked per day, and not having private health insurance. In multivariate analyses, night-smoking at assessment remained a significant predictor of smoking at 26-week follow-up when controlling for other factors associated with treatment outcome (adjusted odds ratio: 0.77, 95% confidence interval: 0.62–0.96). Night-smokers also experienced a shorter average time to relapse (38.5 vs. 56 days, p

Summary Introduction Prior research has shown that the transdermal nicotine patch is a safe and effective aid to smoking cessation, but adherence to the directed use of the nicotine patch is often low. Few studies have examined participant-reported reasons for non-adherence to nicotine patch therapy during a quit attempt. Aims The aim of this study was to evaluate adherence to nicotine patch therapy and to identify participant-reported reasons for non-adherence. Methods Participants were 201 current daily smokers who were offered 6-weekly group treatment sessions and were asked to report nicotine patch use and barriers to use. Results Seventy-one (35.3%) participants were adherent for the first 28 days of treatment and 130 (64.7%) participants were non-adherent. Commonly reported reasons for non-adherence were forgetting to put the patch on (30%), not liking the experienced side effects (15%), resuming smoking (10%) and difficulty affording the cost of the patches (7%). Conclusions Participant- reported barriers to adherence of nicotine patch therapy can be mitigated with advice from healthcare providers. Some examples of advice to patients could include carrying an extra patch, using community resources to obtain free or reduced cost nicotine patches, reviewing the effectiveness of nicotine replacement, and explaining side effects associated with the use of the nicotine patch.

Previous studies of tobacco dependence treatment have reported very low cessation rates among smokers who relapse and return to make a subsequent formal attempt to quit. This retrospective cohort study examined 1745 patients who attended a tobacco dependence clinic between 2001 and 2005, and the characteristics and outcomes of those who relapsed and returned for repeat treatment. Patients who returned for repeat treatment showed higher markers of nicotine dependence and were more likely to have a history of treatment for mental health problems than patients who attended the clinic for only one treatment episode. Among patients who relapsed and returned for repeat treatment, the 26-week abstinence rates were similar for each consecutive quit attempt (23%, 22% and 20%). Clinicians should encourage smokers who relapse after an initial treatment episode to return for treatment, and repeat treatment should focus on addressing high nicotine dependence and potentially co-occurring mental health problems in order to improve cessation outcomes.

Smoking cessation has major health benefits for men and women of all ages. However, most smokers are addicted to nicotine and fail repeatedly in their attempts to quit. Stimulation of nicotinic receptors in the brain, particularly alpha4beta2 receptors, releases dopamine in the meso-limbic area of the brain and is reinforcing. Nicotine abstinence reduces dopamine release, and this is associated with withdrawal symptoms and craving for nicotine. Eight current pharmacotherapies--bupropion, nortriptyline, clonidine and nicotine patch, gum, inhaler, lozenge and nasal spray--are moderately effective aids to smoking cessation. Each is significantly better than placebo, but approximately 80% of patients using one of these medications return to smoking within the first year. Varenicline, a specific alpha4beta2 nicotinic receptor partial agonist, is a new pharmacotherapy that stimulates dopamine and simultaneously blocks nicotine receptors. Phase II and III trials have yielded promising results suggesting that varenicline could be an important advance in the treatment of nicotine dependence.

Nicotine replacement therapies (NRT), in the form of nicotine patch, gum, lozenge, nasal spray and inhaler, are primarily licensed as aids to long-term smoking cessation. The evidence that they are safe and effective at increasing smokers' chances of long-term quitting is very solid (1,2). It is also clear that one important mechanism of action of NRTs is that they reduce the severity of nicotine withdrawal symptoms and cravings to smoke (3,4).